FirstCare Health Plans Quality Improvement Program

FirstCare Advantage Dual SNP (HMO SNP) cares about you, no matter your age or your health plan. We want you to get the care you need and for it to be the best care. We want you to be happy with your care. You may not know it, but FirstCare is always looking at your care and trying to make it better. Our goals are for you to stay healthy, not get sick, and be satisfied with us. We work closely with our staff and doctors to make your care better and meet our goals.

Quality Improvement Program Methods

FirstCare looks closely at the quality of our care and services. We use things like quality scores, reports, and member and doctor surveys to see how we are doing. We set goals to keep getting better, and monitor how close we are to meeting those goals in areas such as:

The quality of your care;

How fast and easy you can get care;

If you get vaccines to prevent disease;

How well you and your doctor talk about your care;

How satisfied you are with your care and services.

When FirstCare sees things that need to get better, we make changes to fix them. We then check to make sure they do get better.

FirstCare Programs for Qualified Members
FirstCare offers many programs to make our care and services even better. These include:

Case Management: This program assigns Case Managers to members who need help getting with care. They teach and help members to manage their health, follow their doctor’s plans of care, and get the care they need.

Disease Management: This program provides education and support to members who have certain chronic conditions.

Medication Therapy Management: This program connects members to a pharmacist who helps them manage their medicines.

Utilization Management: This program helps control costs and ensure the medical need for medicines, surgeries, and hospital stays.

Nurse Line: This is a free phone service for members that allows them to talk with a nurse about their health concerns. It is answered by a nurse 24 hours a day, seven days a week.

Participating in Your Own Care

You play a vital role in using FirstCare to make your health better. We encourage you to talk to us. Here are ways you can take part:

Let us know about any problems

Call FirstCare Customer Service for any problems with our care or services.

Ask Questions

Talk with your doctor about your health. Get answers to your questions. Make sure you understand your treatment plan, so you can follow it.

Educate Yourself

Read FirstCare's newsletters for tips on how to make your health better.

Use the extra services we provide

You may be asked to take part in one more of our programs to improve your care. Please consider using them.

Give us Feedback

Give us your suggestions for improvement by calling Customer Service. You can also complete FirstCare or CMS surveys, which gives FirstCare valuable feedback for future improvements.

At FirstCare Advantage Dual SNP, our first priority is the quality of your care and services. We value your opinion and want you to share it with us. Simply call one of our specially trained Customer Experience staff, and we’ll listen.

If you have any questions, please call FirstCare Advantage Dual SNP (HMO SNP). We are available:

Resources

Access a Doctor, 24/7/365

FirstCare Virtual Care—powered by MDLIVE lets you connect with a doctor from wherever you are. For more details, click here.

Talk to a Nurse—Nurse24™

Need care advice? Should you see a doctor? Get the info you need today! FirstCare members can talk to a nurse 24/7 by calling 1-855-828-1013 to get answers 24 hours a day, 7 days a week! TTY users can call 7-1-1 or 1-800-955-8771. Voice communication is available at 1-800-955-8770.

Utilization Management

Ever wonder how we decide what services to authorize? Our utilization management (UM) decisions are based on medical evidence and consensus of health care professionals. For more details, click here.

How to Learn More

Schedule a sit-down:
Feel free to contact us, and a FirstCare Advantage Dual SNP (HMO SNP) representative will gladly sit down with you and compare the plans in greater detail.

Call us at:
1-866-229-4969
We are available;
October 1- March 31, 8 a.m. to 8 p.m. Central Time (CT) daily;
April 1- September 30, 8 a.m. to 8 p.m. Central Time (CT) Monday through Friday.

For TTY or for accommodation of persons with special needs, please call TTY 7-1-1.